Four function surgical instrument

ABSTRACT

A unique four function surgical instrument that performs aspiration, irrigation, dilation and cauterization with an innovative trigger mechanism. An embodiment is “gun-like” in configuration having a housing with a depending handle and a protruding trigger, a forward extending pair of forceps-like arms that terminate in dilation/cauterization tips and a common conduit between the forceps-like arms. The unique trigger mechanism utilizes a pinch valve concept where the trigger button has an elongated portion that has two slide surfaces with offset a recesses that act like tracks on which pinch sliders follow and the pinch sliders act like valve stems that squeeze close and allow to open silicone tubing. The end result, being a single poll, two stage actuator such that a half a pump of the trigger delivers irrigation or aspiration and a full pump delivers the other. The instrument provides the advantages of small size, ergonomical and all-in-one so as to eliminate the need for a surgeon to fumble around in switching between instruments.

CROSS REFERENCE TO RELATED APPLICATIONS

This application is a divisional of U.S. patent application Ser. No.12/020,560, which is a continuation-in-part of U.S. patent applicationSer. No. 11/471,067 filed Jun. 20, 2006, and claims the benefit ofProvisional Patent Application Ser. No. 60/692,479 filed Jun. 21, 2005,which applications and their contents are incorporated herein by thisreference.

BACKGROUND OF THE INVENTION

1. Field of the Invention

This invention is in the field of surgical instruments and moreparticularly in the field of vessel dilators.

2. Related Art

A leading cause of mortality and morbidity of surgical patients ishospital borne disease transmission between patients. There are manymachines and procedures for sterilizing and cleaning surgicalinstruments, including autoclaving. Despite the severity and rigor ofthese machines and procedures, the cleaning of the instruments is lessthan optimal. Specifically, blood denatures and hardens in crevices orembeds onto restricted areas of an instrument such that there aredeposits of blood that remain after cleaning. These deposits of bloodthat remain after cleaning contain live pathogens. The result being thatthere is a risk of the transmission of disease from patient to patient.

It is theorized that humankind will never be able to devise a machineand/or process that in an economical and practical manner will optimallyclean surgical instrument. Accordingly, it would be desirable to havesurgical instrument that are disposable without compromising theefficacy and the cost effectiveness of performing surgery.

One type of surgical instrument is a vessel dilator. As the nameimplies, a vessel dilator provides intra-luminal vessel dilation duringsurgery. Vessel dilators are frequently used during surgical proceduresas aid in fine dissection and vessel anastomosis. A conventional vesseldilator can be conceptualized as a modified forceps having elongatedparallel tips which are highly polished. The parallel tips are pressedtogether to provide a single tapered shaft. The tapered shaft isinserted into a vessel and the parallel tips are allowed to separatethereby dilating the vessel. As a vessel dilator is inserted into avessel, the dilator helps to hold the vessel wall and to avoid suturingthe back wall to the front wall of the vessel.

Another type of surgical instrument is an irrigation instrument. Often,when a vessel is to be sutured, the vessel must be irrigated using anirrigation instrument. Irrigation is used to prevent drying of tissue,to remove tissue debris and blood, to keep vessel ends open and preventfloating adventitia at vessel ends interrupting satisfactorymicrovascular suturing and anastomosis. Irrigation keeps the operativefield clean and inhibits blood clotting inside the lumen of the bloodvessel.

Another type of surgical instrument is a suction instrument. Suctionkeeps the operative field clean and inhibits blood clotting inside thelumen of the blood vessel.

Another type of surgical devise is a cauterization instrument.Cauterization seals vessels and arrest bleeding. One conventionalcauterization instrument is a bipolar-type blood vesselcoagulation/stanching devise. Such a conventional devise employs a sparkgap methodology using high-frequency current ranging between 0.5 to 3MHz. This bipolar type devise has two electrodes (active and inactiveelectrodes) which are provided at both ends of a pair of forceps thatare held by hand. Electric current flows only through the living tissueheld between the ends of the forceps. Since electric current to apatient is applied only to a limited portion to be coagulated, bleedingfrom a blood vessel can be stopped completely without injuring othertissues. More specifically, the cauterization effect of the devise isobtained by coagulating the blood vessel using localized heating causedby the high-frequency current flowing through the living tissue.

Another surgical procedure of relevance here is anastomosis. Anastomosiscovers a variety of procedures in which blood vessels (or other tubularmembers) are joined or reconnected. Vessels may be joined in a varietyof relative orientations, including end-to-side and end-to-end.Anastomosis is traditionally performed by suturing the vessels togetherat the juncture between them. Alternatives to suturing have beendeveloped, in order to prevent thrombosis which tends to occur at thepoints of penetration of the sutures. One such alternative, particularlyfor larger vessels, involves mechanical connectors such as collars. Asecond alternative is the use of surgical clips which are applied alongthe vessel juncture to perform a holding function similar to that ofsutures, without penetrating the vessel walls.

A surgeon alternates amongst dilation, irrigation, suction andcauterization, during vessel dissection and anastomosis, using separatedilation, suction, irrigation and cauterization instruments. The act ofswitching among these four instruments is time-consuming and caninterrupt the surgeon's attention and concentration.

In Bayat, A., A Novel, Triple-Function Vessel Dilator, Plastic AndReconstructive Surgery, January, 2003, volume 111(1), pp. 501-502(American Society of Plastic Surgeons) and in Bayat, A. et al., A NovelIrrigating Vessel Dilator for Microsurgery, Plastic and ReconstructiveSurgery, September, 2001, Vol 108(3), pp. 798-799, Applicant hereininvented a three functional vessel dilator performing the functions ofdilation, irrigation and suction during vessel dissection andanastomosis. Still, when suturing a blood vessel or otherwise performingoperative tasks, a surgeon must alternate between this three functionalvessel dilator and a cauterization instrument. Alternating between thesetwo instruments is time consuming and interrupts the surgeon'sattention.

In patent application Ser. No. 11/471,067 upon which this application isa continuation-in-part and which is incorporated herein by reference asfurther referred to herein below, there is taught the ingenuity of afour function microsurgical instrument performing the functions ofaspiration, irrigation, dilation and cauterization in a novel andunobvious design. Referring to FIG. 1 of application Ser. No.11/471,067, the instrument has a body with forceps-like arms. A plungervalve extends perpendicular from the body in a direction away from aside region and is positioned for actuation by a user (see, FIG. 1,reference numerals 12 and 30). This ingenuous design advanced the art;but, there were stell needs for an instrument with even more enhancedergonomics, better stability, ease of use and use which did requirerepositioning of a user's finger from gripping a forceps-like arm tocontacting a plunger valve so at to actuate the valve.

Accordingly, there exists a need for an all-in-one, simple to use, easyto handle, lightweight, atraumatic macrosurgery and/or microsurgicalinstrument that improves the overall efficiency of operative procedures.There exists a need for a surgical instrument configured so that all thefour functions of dilation, suction, irrigation and cauterization fittogether in one instrument and enabling a surgeon to perform operativetasks without having to switch instruments. There is therefore a needfor a four function vessel dilator performing the functions of dilation,irrigation, suction and cauterization for use, including, during vesseldissection and anastomosis. There exists a need for an instrument formicrosurgery that provides the advantages of being small in size, beingergonomical, being all-in-one, eliminating the need for a surgeon tofumble around in switching between instruments, reducing timeconsumption and reducing frustration.

There exists a need for a surgical instrument possessing the functionsof dilation, irrigation, aspiration and cauterization where the user isNOT required to reposition and move the user's finger from gripping aforceps-like arm to the finger contact area of an actuation means forcontrolling irrigation-fluid and aspiration-suction.

There exists a further need for a surgical instrument possessing thefunctions of dilation, irrigation, aspiration and cauterization wherethe mechanism for controlling irrigation-fluid and aspiration-suctionoccupies a small and minimized volume such that it is containable in aninstrument for microsurgery.

There exists a further need for a surgical instrument possessing a valvethat has a high level of ergonomics; in particular, there would be abiometrically comfortable force to actuate the valve, a short traveldistance for actuation, non-awkward finger positioning and a high levelof instrument support within the hand.

There is a need for a totally disposable instrument that is low in costand avoids the transmission of pathogenic agents, because currentsterilization techniques are not totally fail-safe.

The present invention satisfies these needs, as well as others, andgenerally overcomes the presently known deficiencies in the art.

SUMMARY OF THE INVENTION

The present invention is directed to a novel and innovative surgicalinstrument possessing the four functions of vessel dilation, irrigation,aspiration and cauterization in a unique configuration. The instrumentcan have a unique and innovative trigger mechanism that is a singlepoll, two stage actuator such that a half a pump of the trigger deliversirrigation or aspiration and a full pump delivers the other.

An object of the present invention is the combined functions of vesseldilation, irrigation, aspiration and cauterization into a singleinstrument. An interrelated object is easier use, less mistakes andreduced fatigue compared to the use of separate instruments.

An object of the present invention is a single actuator for controllingboth irrigation fluid and aspiration suction. Interrelated is theobjective of a single pole mechanism that controls both irrigation andsuction.

An object of the present invention is an instrument that can easily bemanipulated in a controllable fashion.

An object of the present invention is an instrument that is comfortableto use. An interrelated object is an instrument where fingers aredeployed in natural positions and especially where fingers are deployedwith a natural curl. An interrelated object of the present invention isan instrument that fits comfortably in the palm of user's hand betweenthe first joints of the user's index and middle fingers and the fleshyportion underneath the user's thumb known as the thenar eminence.

One aspect of the present invention is a unique and innovative surgicalinstrument possessing the four functions of vessel dilation, irrigation,aspiration and cauterization. The surgical instrument has a housingcomponent which is comprised of three subcomponents. The firstsubcomponent is a body portion having a longitudinal axis so as todefine forward and posterior directions. The second subcomponent is ahandle portion that extends downward from the body portion. The thirdsubcomponent is a butt that extends from the body portion in theposterior direction.

There are a pair of oppositely opposed forceps-like arms that extend inthe forward direction from the body portion. They are resilientlymounted to the body portion and insulative with each forceps-like armhaving a distal end. At each distal end of each of the forceps-likearms, there is a dilation tip that is electrically conducting andcommunicable with electrical power.

A common conduit extends in the forward direction from the body portion.It delivers irrigation-fluid and aspiration-suction in proximity to thedilation tips. There is a trigger button means mounted to the housingthat is positioned for actuation by the user. The trigger button meansis in communication with a triggered controlled irrigation-fluid andaspiration-suction transmission system which is in fluid communicationwith the common conduit.

This aspect of the present invention can be qualitatively conceptualizedas having a gun-like configurations or “T”-like configuration.Alternatively, it can be qualitatively conceptualized as having a handlewith front forceps-like arms that are balanced by a posterior butt.

Another aspect of the present invention is a unique and innovativetriggered controlled irrigation-fluid and aspiration-suctiontransmission system for a novel surgical instrument. This mechanism hasa trigger which has a forward portion and a posterior portion. Theposterior portion has a first elongated slide surface which has a firstrecess. The posterior portion also has a second elongated slide surfacethat is substantially parallel to the first elongated slide surface andwhich has a second recess where said second recess is posterior relativeto the first recess. The trigger displaces in the posterior direction.There is a means for biasing the trigger forward.

There is first a pinch slider that has a first pinch surface and anoppositely opposed first ride surface. The first ride surface rides onthe first elongated slide surface of the posterior portion of thetrigger. There is a second pinch slider that has a second pinch surfaceand an oppositely opposed second ride surface. This second ride surfacerides on the second elongated slide surface of the posterior portion ofthe trigger. Both pinch sliders move back and forth as the trigger isdisplaced in the posterior direction.

Opposed to the first pinch surface and spaced apart a distance therefrom is a first pinching back surface. This first pinching back surfaceis spaced apart a distance from the first pinch surface such that a tubecan be seated between the first pinching surface and the first pinchingback surface such that the tube will have a substantially open lumenwhen the first ride surface rides in the first recess and has a pinchedclosed lumen when the first ride surface rides otherwise on the firstelongated slide surface.

Opposed to the second pinch surface and spaced a distance apart therefrom is a second pinching back surface. This second pinching backsurface is spaced apart a distance from the second pinch surface suchthat a tube pan be seated between the second pinch surface and thesecond pinching back surface such that the tube has a substantially openlumen when the second ride surface rides in the second recess and has apinched closed lumen when the second ride surface rides otherwise on thesecond elongated slide surface.

This aspect of the invention can be qualitatively conceptualized ascomprised of a trigger button with an elongated portion that hasrecesses and acts like a track. The pinch sliders act like valve stemsthat follow on the recesses. The pinch sliders press against siliconetubing so as to squeeze close and open the silicone tubing. The endresult, including, being a single poll, two stage actuator.

The present invention has many advantages which include the following.The present invention has the advantages of being ergonomical and lightweight whereby it sits well in a user's hand, reduces fatigue,facilitates fluid and accurate movements, facilitates ease of use andenhances control. The instrument has the advantage of eliminating theneed for a surgeon to use multiple instruments and commensurately, thenumber of assistance to a surgeon. Overall, the instrument has theadvantage of reduces operating time and concomitantly, reducingoperating error, the amount of anesthesia and cost. The entireinstrument is sufficiently inexpensive to be totally disposable. This isparamount to safety for the cleaning of surgical instrument is usuallysuboptimal with blood getting stuck on the instrument, after cleaning.

BRIEF DESCRIPTION OF THE DRAWINGS

These and other features, aspects and advantages of the presentinvention will become better understood with reference to the followingdescription, appended claims and accompanying drawings where:

FIG. 1 is a perspective view of the exterior of an embodiment of thepresent invention looking onto a left side;

FIG. 2 is a perspective view of the exterior of an embodiment of thepresent invention looking down onto a top side;

FIG. 3 is a perspective view of the exterior of forceps-like arms anddilation tips according to the present invention looking down onto a topside;

FIG. 4 is a perspective view of the interior of an embodiment of thepresent invention looking onto a left side;

FIG. 5 is a perspective view of a triggered controlled irrigation-fluidand aspiration-suction transmission system according to the presentinvention;

FIG. 6 which is a side view that shows a triggered controlledirrigation-fluid and aspiration-suction transmission system according tothe present invention;

FIG. 7 is a side view that shows a triggered controlled irrigation-fluidand aspiration-suction transmission system according to the presentinvention;

FIG. 8 which is side view of the exterior of an embodiment of thepresent invention looking onto a left side;

FIGS. 9A and 9B are graphs plotting force to displace a trigger versesdisplacement and

FIG. 10 is a perspective which shows an embodiment of the presentinvention held in an user's hand.

DETAILED DESCRIPTION OF THE INVENTION

The invention is a unique and innovative all-in-one four functionmicrosurgical instrument with a unique trigger design which performs thefunctions of aspiration, irrigation, dilation and cauterization. Theinstrument is ergonomical and user friendly whereby it can be sized forbeing a mirco-instrument designed for work with say vessels having adiameter of about one or about two millimeters. The instrument can alsobe sized for being a macro-instrument designed for work with sayintestines.

Overview of the Housing

Referring to FIG. 1, the surgical instrument (1) of this invention has ahousing (5). This housing (5) is comprised of body portion (10), handleportion (60) and butt portion (50). As discussed further herein below,typically; this housing (5) if of an industrial design such that it isintegral with forceps-like arms (20, see, infra.) and is that ismanufactured as a right tray and left cover which are pressed orfastened together.

Body Portion

Referring to FIG. 1, the body portion (10) has a longitudinal axis so asto define forward and posterior directions, a pair of oppositely opposedlateral sides, front side and an upper side. If the handle portion (60)is narrower than the body portion (10), the body portion can have alower side (see, discussion, infra.)

Handle Portion

Referring to FIG. 1, the handle portion (60) depends (loosely meaningextends downward when the instrument is in a horizontally proneposition) from the body portion (10) so as to define a lower direction.The can depend perpendicular or at a angle, with perpendicular beingpreferred. Referring to FIG. 10, the handle portion has oppositelyopposed lateral sides, a forward side, a lower side and a posteriorside. The handle portion (60) has a width and length that is suitablefor grasping in the area of a user's palm between about thenar eminenceand about the first joints of the user's first finger (thumb) and second(index) finger.

Referring to FIG. 10, preferably, the width of the handle portion (60)is sized such that when posterior arcuate (62, see, infra) of the handlepotion (60) buttresses against the thenar eminence of a user's hand, thethird (middle) finger of the user's hand naturally curls and rests onthe finger contact surface or surfaces of a trigger button means (110,210, 310). Preferably, the handle portion (60) extends in the lowerdirection sufficiently for stable support of the instrument (1) by theuser. Referring to FIGS. 1 and 7, in embodiments of the invention havinga single or dual plunger-like trigger button means (110, 310), mostpreferably, the length of the handle portion (60) is long enough suchthat the finger contact surface or surfaces of the trigger button means(110, 210, 310) aligns with the third (middle) finger and is not so longthat the bottom of it contacts with or interferes with the a usercurling the user's fourth (ring) finger and fifth (pinkie) finger.

Referring to FIG. 1, the handle portion (60) has a posterior arcuate(62). Referring to FIG. 10, this posterior arcuate (62) sits in thefirst web space of an user's hand and is appropriately sized to fit inthat webspace. Preferably, the radius of curvature of the posteriorarcuate (62) is not so small at to pinch the thenar eminence.Preferably, the radius of curvature of the posterior arcuate (62) is notso great such that there are gaps or spaces between the arcuate surfaceand the thenar eminence. In an embodiment of the invention, usingstraight line approximations, the arcuate surface would fit into therays of an about 75 degree to an about 88 degree angle. Accordingly, theposterior arcuate (62) forms a saddle to sit in the first web space ofuser's hand and rests against thenar eminence of the user's hand.

Referring to FIGS. 1 and 10, the lower surface of the handle portion(60) can be arcuate (64) to accommodate the user's fourth or fifthfinger which may be at least partially extended or curled below thelower surface of the handle portion (60). The forward side of the handleportion (60) is typically linear and can slightly angle in the posteriordirection so the user's middle finger naturally curls onto the fingercontact surface of a trigger button means (115, 215, 216, 315).

Butt Portion

Referring to FIG. 1, there is a butt portion (50) that extends posteriorfrom the body portion (10) about along the longitudinal axis of the bodyportion (10). In alternative embodiments, the butt portion (50) can beat a modest angle relative to the longitudinal axis. Referring to FIG.10, typically, there is an upper side, oppositely opposed lateral sides,a posterior side and a lower side. Preferably, the lower side isrestable on and extends over at least a portion first dorsal web spaceof a user's hand.

In alternative embodiments, the extension of the butt portion (50) canbe very minimal down to a negligible posterior side of the body portion(10). Referring to FIG. 2, preferably, the length of the butt portion(50) makes the instrument (1) balanced; that is, it functions,including, as a counterweight to the forceps-like arms (20). Preferably,the length of the butt portion (50) should not be too long so as to makethe instrument (1) to heavy. Referring to FIG. 10, preferably, thelength of the butt portion (50) should not be too short such that theinstrument does not rest comfortably over the first dorsal web space ofthe user's hand so as to provide stability.

Referring to FIG. 2, there is one or more openings (52) in back of thebutt portion (50) that are sized to run out two tubes (410, 420) and awire (86). In alternative embodiments, this opening (52) or theseopenings (52) are on the top side of the butt portion (50) or at otherpoints elsewhere about the housing (5). The out-routing of these twotubes (410, 420) is further discussed below.

Forceps-Like Arms

Referring to FIG. 1, there are a pair of oppositely opposed forceps-likearms (20) that extend forward from the body portion (10) on orapproximately along the longitudinal axis of the body portion (10). Inalternative embodiments, the forceps-like arms (20) can be at a modestangle relative to the longitudinal axis. Each of the forceps-like arms(20) has a distal end (22). Extending past the distal ends (22) aredilation tips (40, see, infra.)

The forceps like arms (20) extend in substantially parallel fashion fromthe body portion (10). Typically, the forceps-like arms (20) tapergradually to a narrow breadth as distance increases from the bodyportion (10).

The forceps-like arms (20) are insulative (preferably, non-conducting.)Referring to FIG. 10 and as explained further below, a user's firstfinger (thumb) and second (index) finger contact the forceps-like arms(20). Insulative means that at least the intended finger contact areafor one of the user's fingers is non-conducting. Preferably, the entireforceps-like arm (20) is non-conducting. In embodiments of theinvention, non-conducting does not mean a particularly high resistancethat no current at all flows and means that a user is not distracted,annoyed or harmed by any current that might flow. Insulative to thedegree of being non-conducting is preferred.

The forceps-like arms (20) are resiliently mounted to the body.Referring to FIG. 2, typically, the forceps-like arms (20) are integralwith the housing. In such a configuration, resilient means that in aresting state of the instrument, the forceps-like arm (20) are spreadapart and capable of deforming when squeezed so as to bring together thedilation tips (40) and thereafter return to about a resting state ofbeing about spread apart.

The forceps-like arms (20) can be a separate structure that is hingemounted to the body portion (10) or mounted by way of a docking station(see, discussion below on a modular instrument.) In a hingedconfiguration, resilient mounting is accomplished by way of a torsionspring of a compression spring on the inside of the hinged joint or anelastic band or spring running over the outside of the hinged joint.

Optionally, there is a gripping pad (24) on the exterior of theforceps-like arms (20). The gripping pad (24) can be a widened area ofthe forceps like arms (20). In addition or alternatively, the grippingpad (20) can be a depression or recess. In addition or alternatively,the surface of the gripping pad (20) can have knobs, protrusions,striations and/or a grating. Preferably, the gripping pad (20) ispositioned along the exterior of the forceps-like arms such that the tipof the user first finger (thumb) or second (index) finger rests on thegripping pad (20) in an anatomically natural position.

In another embodiment, the outer surfaces of the forceps-like arms (20)is provided with undulations which facilitates gripping. In anotherembodiment, there can be a thumb/finger tab that projects from aforceps-like arm (20) and is positioned to enhance gripping, control andthe ergonomics of the instruments. This thumb/finger tab can furtherhave an array of recesses, protrusions or nodulations to further enhancegripping.

Dilation Tips

Referring to FIG. 3, there is a dilation tip (40) at each distal end ofeach of the forcep-like arms (20) that is electrical conducting andcommunicable with an electrical power source which preferably hasactuation means for the electrical power. Typically, the dilation tip isan elongated metal bar that tapers to a point. Preferably; the metal isstainless steel of a fine enough grade to be shapeable into a tip, aspreviously described.

Referring to FIGS. 3 and 4, typically, the dilation tip has a firstlength (42) and a second length (44). The first length 42) runscoextensively with the distal end of the forceps-like arm (20) and isembedded or otherwise affixed to the forceps-like arm (20). Preferably,this first length (42) has a narrower width then a second length (44)(discussed below.) Thus this first length is like a recess with ashoulder (at the point of the beginning of the second length (42) so asto facilitate attachment of the dilation tip (40) to the forceps-likearm (20).

There is a second length (44) of the dilation tip (40) that extends fromthe distal ends of the forceps-like arms (20). The second length of thedilation tip (44) can be configured for contacting a blood vessel and isapproximately shaped like “b” rotated 90 degrees or sharpened/taperredto a point. The outer surface of this second length (44) can be flat orrounded.

Referring to FIG. 3, preferably, at the distal end of each of thedilation tips (20) on the inner sides of the second lengths (44) (thatis, the sides that oppose each other on the dilation tips (40)) there isa ridge (46). These opposing ridges (46) perform the function of stopsto spread the inner surfaces of the dilation tips (40) near the distalends. The gap thereby created is utilized as room for a common conduit(30, see, infra.)

In another embodiment, there is a groove in the inner surface of theforceps-like arm (20) (that is, the surface that opposes the otherforceps-like side arm (20).) The common conduit (30, see, infra.) istotally received in this groove so as allow the dilation tips to closetogether (40) in near perfect approximation. In another embodiment, thegroove is dimensioned so that the common conduit (30) partially fitsinto a first forceps-like arm (20) and there is a groove in the innersurface of the second forceps-like arm (20) that mates with the commonconduit (30) which is partially recessed in the first forceps-like arm(20). Thus, when the two forceps-like arms (20) are pressed together,this groove allows the dilation tips (40) on each of the forceps-likearms (20) to close with near perfect approximation.

Common Conduit

Referring to FIGS. 2 and 3, there is a common conduit (30) for thedelivery irrigation-fluid and aspiration-suction in proximity to thedilation tips (40). The common conduit (30) extends forward from thebody portion (10) about along the forceps-like arms (20). The commonconduit (30) can be positioned between the opposing forceps-like arms(20). It can also be positioned to run along or inside a forceps-likearm (20) with a suitable exit port fixture to direct the flow ofirrigation-fluid and aspiration suction. The common conduit (30) can bepositioned outside the pair forceps-like arms (20) with a suitable exitport fixture to direct the flow of irrigation-fluid and aspirationsuction. Preferably, the common conduit (30) is centrally locatedbetween the forceps-like arms (30) such that when the forceps-like arms(20) are pressed together, the common conduit (30) is locatedimmediately behind the dilation tips (40) mounted on the forceps-likearms (20).

The term common conduit (30) includes a single conduit, two separateconduits, co-axial conduits with two channels and side-by-side conduitstrips where there are two conduits/channels with one delivering fluidand the other suction. Typically and preferably, the common conduit (30)is a single tube, channel or conduit. Preferably, the end of the commonconduit (32) near the dilation tips tapers down to a needle like point.

Referring to FIG. 4, in an embodiment of the invention, there is aY-connector block (36) which is a forward facing interface positioned onthe front side of the body portion. Typically, the Y-connector is justbelow a two hole bridge (82) for running electrical wires. Preferably,the Y-Connector block is integral with the 2 hole bridge (82) and the 2hole bridge (82) buttress against the upper side of the body portion(10).

Continuing to refer to FIG. 4, in this embodiment of the invention,there is a spar tube (34) is inserted into the Y-Connector block (36)and extends there from.

A pipette tip, needle or cannula (32) is attached to the spar tube (34)and forms the end of the common conduit (30). An example of a suitableplastic needle (32) is a standard mini Yankauer, which is conventionallyused as a cannula in pediatric anesthetic catheters. The pipette tip,cannula or needle (32) are either fixedly or irremovable mounted to thespar tube (34). The pipette tip, needle or cannlula (32) is typicallypushed onto the end of the spar tube (34). Friction between the insidesurface of the pipette tip, needle or cannula (32) with the outsidesurface of the spar tube (34) is usually sufficient to hold the pipettetip, needle or cannula (32) in place. A nipple or sleeve can be used tojoin the pipette tip, needle or cannula (32) onto the end of the spar(34).

In an embodiment of the invention, there is a pipette tip, needle orcannula (32) attached to a central spar tube (34) which extends from aY-connector block (36) positioned at about the front side the bodyportion (10).

Referring to FIG. 3, the common conduit (30) delivers irrigation-fluidand aspiration-suction in proximity to the dilation tips (40) and is influid communication with a triggered controlled irrigation-fluid andaspiration-suction transmission system (100, 200, 300). Proximity doesnot connote any particular distance and means an operative distance soas to deliver irrigating fluid, or when switched, aspiration/suction, inthe area of the dilation tips (30). One millimeter or less ispreferable. The function provided by the common conduit (30) isdetermined by an irrigation-fluid and aspiration-suction control andtransmission system. When aspirating, the common conduit (30) can beused to extract fluid.

In a most preferred embodiment, the tip or end of common conduit (32) isset back to allow the dilation tips (40) of forceps-like arms (20) toclose. As discussed herein, the dilation tips (40) can have opposingridges (46.) The end of common conduit (32) approaches the start of theridges (46). Thus, the ridges (46) provide room for the end of thecommon conduit (32) when the dilation tips (30) are pressed or squeezedtogether.

Triggered Controlled Irrigation-Fluid and Aspiration-SuctionTransmission System

Referring to FIGS. 4, 5, 6 and 7, there is a triggered controlledirrigation-fluid and aspiration-suction transmission system that ispartially disposed in the housing that is in fluid communication withthe common conduit (30) and sources for fluid and vacuum. It ispartially disposed in housing for at least the reason that a triggermeans extends out from the housing and there are tubes outside thehousing. This system is comprised of a control system (100, 200, 300)and a transmission means (410, 420).

Control System Subcomponent

Referring to FIGS. 4, 5, 6 and 7, the control system has a triggerbutton means (110, 210, 310) mounted to the housing (5) that ispositioned for actuation by the user and most preferably, mounted to thehandle portion (60). The trigger button means (110) can have thestructure of being a single plunger-like button (110) which travels alongitudinal distance as illustrated in FIG. 5. It can have thestructure of a dual plunger-like button (310) which travels alongitudinal distance as illustrated in FIG. 7. It can have thestructure of a rocker-like switch (210) as illustrated in FIG. 6. It canhave other structures such as like a slide switch.

A single or dual plunger-like button (110, 310) which travel alongitudinal distance are preferred because, this facilitates actuationby a user with the user's third (middle) finger with relatively littleor no repositioning of the user's third (middle) finger. This is incontrast to a rocker-like switch button (210) which requires relativelygreater repositioning movement by the user of the user's third (middle)finger between the two finger contact surfaces of the rocker-like switchbutton (210). A single plunger-like button (110) which travels alongitudinal distance is most preferred because, it requires norepositioning of the user's third (middle) finger and therefore hasenhanced ergonomics and simplicity of use.

Trigger force can be reduced by using materials with a lower coefficientof friction compared to other materials. This in turn enables the use ofa softer spring (135). In embodiments of the present invention, thetrigger force is at least great enough that the trigger is notinadvertently actuated when manipulating the instrument and/orfacilitates gripping and holding of the instrument. In common parlance,the trigger does not feel “mushy.”

Optionally, the finger contact surface of the trigger button (110, 210,310) can be embellished with a ring-like or cage-like structure intowhich an operator inserts the users third (middle) finger. This optionalfeature promotes bipolar motion at the expense of ergonomics.

Optionally, the finger contact surface can have recesses or bumps toenhance finger gripping.

The triggered controlled irrigation-fluid and aspiration-suctiontransmission system that is partially disposed in the housing. Asfurther discussed below, typically, the housing is designed andmanufactured in two halves; that is, a right tray (105, 205, 305) and aleft cover. The right tray has features that are utilized in or areapart of the control system (100, 200, 300).

Preferably, the control system employs a pinch valve concept isemployed.

Referring to FIGS. 4 and 5, one embodiment of the control system (100)works off a trigger button means (110) that is a single buttonplunger-like trigger. There is a trigger button means (110) having aforward portion (115) that extends forward from the housing (5). Thisforward portion has a finger contact surface. There is a posteriorportion (120) that is preferably disposed in the handle portion (60) ofthe housing (5). This posterior portion (120) is bar-like in shape andhas a top surface with features as described below.

The trigger button means (110) is displaceable in the posteriordirection. The trigger is slidably mounted to the housing (5) by way ofa longitudinal elongated slot (131) in the posterior portion (120). Thislongitudinal elongated slot (131) is seated on roller post (130) thatprotrudes from the right tray (105).

There is a means for biasing (135) forward the trigger button means(110). This means can be a compression spring. The compression springspans from the rear of the posterior portion (120) of the trigger button(110) to a shoulder (136) protruding from the right tray (105). It canbe a torsion spring. It can be an elastic band or member. It can be anhydraulic or air cylinder. It can be a motor powered by electricity,pressurized hydraulic fluid or compressed air. A spring is preferred anda compression spring is most preferred. This means for biasing (135) isdiscussed further below.

The top surface of the posterior portion (120) of the trigger buttonmeans has a first elongated slide surface (125) that has a first recess(126) and acts like a track. There is a second elongated slide surface(127) in the top surface of the posterior portion (120) that issubstantially parallel to the first elongated slide surface (125) andhas a second recess (128), where said second recess (128) is posteriorrelative to the first recess. This second elongated slide surface andsecond recess also acts like a track.

There is a first pinch slider (140) and a second pinch slider (150). Thepinch slider (140, 150) can be rectangular, square, round (called apinch cylinder (245, 246) (see, below)) or other suitable shape. Eachhas a pinch surface (142, 152) and oppositely opposed ride surface (141,151). In embodiments of the invention, the pinch sliders (140, 150) havetwo elongated slots (143) (slot not illustrated for second pinch slider)and are mounted on support posts (144) which protrude from the righttray. Preferably, the ride surface (141, 151) of each pinch slider (140,140) is rounded to facilitate riding. Preferably, the pinch surface(142, 152) is a triangular-like to facilitate pinching. In the case of acylindrical pinch slider (245, 246,) then the ride surface (141, 151)and pinch surface (142, 152) are continuous.

As mentioned, there is a first ride surface of the first pinch slider(140). This first ride surface (140) rides on the first elongated slidesurface (125) of the trigger button means (110). The first pinch slider(140) acts like a valve stem and moves back and forth as the firstrecess (126) in first elongated slide surface (125) passes underneath itwhen the trigger button means (110) is displaced. That is, when thefirst recess (126) is underneath the first pinch slider (140), it canmove into a lower position.

There is a first pinching back surface (155) that protrudes form thehousing tray and is oppositely opposed to a first pinching surface (142)of the first pinch slider (140). This first pinching back surface (155)is spaced apart a distance from the first pinching back surface (155)such that a tube (410) can be seated, and preferably conforminglyseated, between the first pinching back surface (155) and the firstpinching back surface (142) with the tube (410) having a substantiallyopen lumen when the first ride surface (141) rides in the first recess(126). The lumen of tube (410) is pinched closed when the first ridesurface (141) rides otherwise on the first elongated slide surface(125). In operation, the first pinch surface (142) buttresses against afirst silicone tube (410) and as it moves back and forth, it squeezesthe tube closed with the resiliency of the tube re-opening it (discussedfurther below.)

As mentioned, the second pinch slider (150) has a second pinch surface(152) and oppositely opposed second ride surface (151). Like the firstpinch slider (140), the second pinch slider (150) has two elongatedslots and is mounted on support posts (144) which protrude from theright tray. The second ride surface rides on the second elongated slidesurface (127) of the trigger button means (110). The second pinch slider(150) acts like a valve stem and moves back and forth as the secondrecess (128) in second elongated slide surface (127) passes underneathit when the trigger is displaced.

There is a second pinching back surface (156) that protrudes from thehousing tray that is oppositely opposed to the second pinch surface(152). The second pinching back surface (156) is spaced apart a distancefrom the second pinch surface (152) such that a tube (420) that isseated, and preferably conformingly seated, between the second pinchingback surface (156) and the second pinch surface (152) has asubstantially open lumen when the second ride surface (151) rides in thesecond recess (128) and has a pinched closed lumen when the second ridesurface rides (151) otherwise on the second elongated slide surface(127). In operation, the second pinch surface (152) buttresses against asecond silicone tube (420). As it moves back and forth, it squeezes thetube closed with the resiliency of the tube re-opening it (discussedfurther below.)

The result being, including, that with about one half displacement ofthe trigger button means (110) the lumen of the first tube (410) is openwith the lumen of the second tube (420) being pinched closed and with anabout full displacement of the trigger button means (110) the lumen ofthe second tube (420) is open with the lumen of the first tube (410)being pinched closed.

Returning to a discussion on the means for biasing (135), the amount ofresistance provided by this means in conjunction with the force requiredto close silicone tubes (410, 420) should be such that it not be sogreat that a user will jerk the instrument or otherwise compromisecontrol. The resistance should not be so small that the trigger feelsoverly soft, does not return to its extended position and/orinadvertently or unintentionally displaces as the user grasp andmanipulates the instrument. Trigger resistance can be modified relatedto slope of ramps (see, by way of inference, Example 5). Returning tothe pinching back surfaces (145, 155). While this second pinching backsurface is claimed distinctly from the first pinching back surface(155), the two can be integral.

Referring to FIG. 6, another embodiment of the control system (200)utilizes a rocker-like trigger button means (210). The trigger buttonmeans (210) has a forward portion (215) that extends forward from thehousing (5). This trigger button means (210) has an axis about which itrotates. At the point of this axis is hole (225). In a right tray (205),there is post (226) that protrudes perpendicular from the right tray(205). The trigger button (210) is rotatably mounted on this post (226)by reception through the hole (225).

The forward portion (215) has two finger contact surfaces (216, 217).One finger contact surface (216) is above the axis of rotation asdemarcated by the hole (225) and the other finger contact surface (217)is below. There is a posterior portion (220) disposed in the handleportion (60) of the housing (5). This posterior portion (220) providesstructural support and balance to the trigger button and is capable ofinterfacing with a biasing spring (discussed below.)

There is a means for biasing with an appropriate amount of resistance. Atorsion spring is the most preferred means for biasing in thisembodiment. The torsion spring is held in a preloaded state with innersurface of inner side of the right tray acting as a stop feature. In thealternative, a stop feature or shoulder can protrude from the righthousing. The legs of the torsion spring contact the posterior portion ofthe rocker switch like trigger button (220). In another alternative,there are trigger ribs to contact the spring legs. Trigger rotation canbe modified related to slope of ramps (see, Example 2.)

There is a slot (230) that is spaced apart from the axis hole (225) andspaced apart from the first contact surface (216). This slot receives apost (235) protruding from a reciprocating member (240) (discussedbelow) so as to form a linkage.

The reciprocating member (240) has a substantially linear slide surface(243) with two recesses (241, 242). There are two pinch cylinders (245,246) that are seated between shoulders that protrude from the internalside of the right housing tray (205). For each pinch cylinder (245,246), there is a pinching back surface which opposes it. These featuresare spaced apart such that a silicone tube (410, 420) seated between apinch cylinder (245, 246) and the pinching back surface has an openlumen when the recess (241, 242) is under the pinching cylinder and apinched closed lumen when the slide surface (243) is otherssieunderneath it. The result being that when the rocker-like trigger buttonmeans (210) is depressed by a user into one or the other of its onpositions, there is two stage valving for irrigation and suction.

Referring to FIG. 7, another embodiment of the control system (300)utilizes a dual plunger-like trigger button means (310). The triggerbutton means (310) has a forward portion (315) that extend forward fromthe housing (5). This forward portion (315) has a contact surface. Thetrigger button (310) has a support post (322) that extends posterior soas to be disposed in the handle portion (60) of the housing (5). Thissupport post travels in channel formed by the lower exterior surface ofshoulder (325) and upper exterior surface of shoulder (326) and therebyprovides structural support for the trigger button (310) to displacelongitudinally.

There is a means for biasing forward the trigger (310). This means canbe a compression spring. The compression spring spans from the rear ofthe posterior portion of the trigger button to a shoulder protrudingfrom the right tray. It can be a torsion spring. It can be an elasticband or member. It can be an hydraulic or air cylinder. It can be amotor powered by electricity, pressurized hydraulic fluid or compressedair. A spring is preferred and a compression spring is most preferred.This means for biasing is discussed further below.

Protruding posterior from the trigger button (310) is a first rod (320)and second rod (321). The rods (320, 321) extend in the posteriordirection so as to be disposed in the body portion (60) of the housing.As explained below, the rods (320, 321) have features. In a right tray,there are two pairs of parallel shoulders (325, 326) that form a channelin which the rods (320,321) travel.

A inner lateral surface of the first rod (320) has a first recess (324).In line with this first recess (324) are openings in pairs of shoulders(325) so that a silicone tube can pass there through. There is a shelfor plate that is fastened to the tray that runs over the inner surfaceof the first rod and functions as a pinching back surface. A innerlateral surface of the second rod (321) has a recess. This second recessis posterior relative to the first recess (322) in the first rod (320).In line with this second recess are openings in the pair shoulders (321)so a silicone tube can pass there through. There is a shelf or platethat is fastened to the tray that runs over the inner surface of thesecond rod and functions as a pinching back surface. Silicone tubes arethread through the aforementioned openings in the pairs of shoulders(320, 321). As the trigger is displaced in the posterior direction, whenthe portion of the rod with no recess is opposite the silicone tube, thetube is closed off. When the trigger is displaced such that a recess isopposite the silicone tube, the tube is open. The result being a mode ofaction and valving where an about half pump of the dual plunger-liketrigger button means (310) turns on irrigation or suction. An about fullpump turns this off and turns on the other.

Returning to the means for biasing, it has an appropriate amount ofresistance as discussed above with respect to a single plunger likemeans for triggering. Trigger resistance can be modified related toslope of ramps (see, Example 5.)

Another embodiment (not illustrated) of the control system is comprisedof a plunger valve as described in the parent application, where onepump actuates irrigation or suction and two pumps actuates the other. Inanother embodiment, the trigger button means and control system arepositioned on the body portion or forceps-like arms, as described in theparent application. In an alternative embodiment, there is a first valvewith a trigger button means extending from the housing (5) andpositioned for actuation by a user and a second valve with a triggerbutton means extending from the housing and positioned for actuation bya user, as more fully described in the parent application. Each valve isin intermittent fluid communication between the common conduit (30) andthe fluid transmission means. The fluid communication means is in fluidcommunication with fluid and vacuum sources.

The irrigation-fluid and aspiration-suction control system (100, 200,300) can be a system with a magnet, motor, hydraulic cylinder,compressed air cylinder or other mechanical assist that may be actuatedby the trigger button means (110, 210 and 310). In one embodiment, thereis an electrical switch, and preferably a momentary contact switch,which actuates a magnet which results in a longitudinal displacement ofa bar-like structure.

Transmission Means Subcomponent

Referring to FIG. 2, there is a irrigation-fluid and aspiration-suctiontransmission means. One structure of this means is a pair of tubes (410,420) which runs through the butt portion (50) and body portion (10). Onetube (410 or 420) provides vacuum and the other tube provides airrigation fluid. As discussed above, these tubes (410, 420) interactwith the control system. Other structures are co-axial conduits with twochannels and side-by-side conduit strips where there are twoconduits/channels with one delivering fluid and the other suction.

In an embodiment of the invention, at the posterior of the butt portion(50) there can be connectors (not illustrated) for the tubing (410, 420)for attachment to vacuum and irrigation fluid sources (not illustrated.)The connectors can be a standard luer lock (a known apparatusconventionally used to connect a needle to an intravenous set.) Inanother embodiment, the butt portion (50) and/or body portion (10) canhave a lid on the top or side to facilitate access to internal area ofthe instrument. In the internal area, there are connectors (ports) forthe tubing (410, 420). When the lid is open, the tubes (410, 420) can beattached to or released from the connectors (ports.)

In an embodiment of the four function surgical instrument (1), a luerlock (not illustrated) on the posterior region of the butt portion (50)is connected to an appropriately sized connecting tube (410, 420)—tubingfrom an intravenous set—which is in turn attached to a 50 millilitersyringe containing heparin/saline. Variation of pressure applied to thesyringe will produce a corresponding variation of the rate of fluid flowfrom the common conduit (30). The rate of fluid flow from the commonconduit (30) can thus be altered at the request an operator.

In another embodiment of the four function surgical instrument (1), oneor both of the tubes (410, 420) are connected to more than one syringethrough a multi-channel connector. Where more than one syringe isprovided, it is possible for more than one assistant to assist withirrigating. The length of the connecting tube (410, 420) can be selecteddepending upon how close or far away a surgical assistant is situatedfrom a surgeon. Commercially available dispensable intravenous sets ofdifferent lengths may be used.

In another embodiment, the fluid may be delivered to the four functionsurgical instrument (1) under pressure using an automated pump. The fourfunction surgical instrument (1) may then include a valve which is usedby the surgeon to control the rate of flow of fluid from or to the fourfunction surgical instrument (1). This valve can be suitably located onthe instrument and preferably on a forceps-like arm 20. It can belocated off the instrument.

Suitable tubes (410, 420) are any flexible plastic tubing. The tubesshould have resiliency as necessitated by the pinch valve concept,discussed above. Standard types of tubes found in Intravenous (IV)giving sets may used. Preferably, the tubes (410, 420) have an insidediameter of about 2 to about 3 millimeters. Preferably, the tubes aremade out of silicone.

Wiring and Electrical

Referring to FIG. 2, the dilation tips (40) at each distal end of eachof the forcep-like arms (20) are electrical conducting and communicablewith electrical power (86) from an electrical power source andpreferably, an actuation means for electrical power (88).

Referring to FIGS. 1 and 4, an elongated electrical conductor originatesat the proximal end of the dilation tip 42 and is in electricalcommunication with the dilation tip 40. The elongated electricalconductor runs laterally along the forceps-like side arm. Preferably,the conductor is embedded in a channel or recess (80) in the innersurface of the forceps-like arms (20). Less preferably, the conductorcan run on the inner surface of the forceps-like sidearm. Lesspreferable, it can be a wire.

At about the proximal end of the forceps-like arm (20), theaforementioned channel or recess (80) is terminated. Each of elongatedelectrical conductors in the recess or channel (80) electricallyconnects with a power wire; that is, a power wire emanates from theinner surface of the proximal end of each of the forceps-like arms Onthe front side of the body portion (20) is two hole bridge (82)positioned as a forward facing face plate. Typically, this two holebridge (82) is located above the Y connector block (36) to which thecommon conduit (30) is inserted and can be integral with the Y connectorblock. Each of the power wires emanating from each of the forceps-likearms threads through one the holes in the two hole bridge (82).

Referring to FIG. 4, inside the housing, protruding from the right trayan elongated shoulder (84) that traverses the length of the body portion(10) and butt portion (50) of the housing (5). This elongated shoulder(84) runs approximately parallel to the upper side of the body portion(10) and the butt portion (84) and is spaced apart there from. The spacebetween the elongated shoulder (84) runs and the upper side of the bodyportion (10) and the butt portion (84) creates a cavity for the powerwire to run through the body portion (10) and butt portion (50 of thehousing (5).

Two separate power wires can run above elongated shoulder (84) in theabove described cavity with two wires exiting the instrument. In thealternative, the two separate power wires can be joined into onemulti-conductor wire wire. This joining can occur just posterior to thetwo hole bridge (82). Accordingly, one wires would exit the instrument.

Referring to FIGS. 2 and 4, as discussed above, in the butt portion (50)there are on or more openings (52) for wire or wires to exit theinstrument (1). Optionally, there can be a connector at the posteriorside of the butt portion (50) to provide a junction for attachment andrelease of an electrical wires.

There is an actuation means for electrical power with one wire goingthrough a switch to a hot side for electrical power and the other wiregoing to ground. Thus an electric circuit is creatable from an electricpower source so that electric power is supplied for bipolarcauterization at the dilation tips (40). In a preferred embodiment ofthe present invention, the actuation means is a foot pedal switch (88).This foot pedal switch (88) is in electrical communication with anelectric power source such that power is turned on and supplied forbipolar cauterization at the dilation tips (40). In other embodiment ofthe present invention, the actuation means for electrical power is amomentary contact switch, touch surface, or throw pole switch.

Embodiments for Macrosurgical Instrument and Microsurgery

The invention herein is scalable to achieve different surgicalutilities. In embodiments of the invention, the instrument can bemacrosized and preferably, it is macorsized about twice the size ofmicrosized instrument. Preferably, embodiments of the invention that area macrosized instrument are similar in outward respects to embodimentsof the invention that are a microsized instruments.

Making

The housing and forceps-like arms can be made out of plastic withpolycarbonate being a preferred plastic. They are manufactured bymolding methodologies with injection molding being preferred.Preferably, they are manufactured in two halves; that is, a right/uppertray and a left/lower tray. The two halves are pressed together orpreferably held together by screw fasteners. Embodiments of theinvention as disclosed herein are suited for low production costs.

Use

The instrument is used as a clinical devise in surgery. It isergonomical, user friendly all-in-one instrument. The instrument canhave an innovative trigger mechanism that is a single poll, two stageactuator such that a half a pump of the trigger delivers irrigation oraspiration and a full pump delivers the other.

It is common in surgery for a surgeon (user) to irrigate, dissect toclean away debris, aspiration, carry out anastomosis to suture a bloodvessel and at any time carry out cauterization. The user utilizes theuser's first (thumb) finger and second (index) finger to manipulate theforceps-like arms (20). The user utilizes the user's third (index)finger to control the trigger button means (110, 210, 310) so as toactuate irrigation and suction. The user utilizes the user's foot tocontrol a foot pedal switch (88) to actuate cauterization.

Embodiments of the invention are a microsurgical instrument for use inoperating on small structures such as nerves and vessels. Themicrosurgical instrument and macro surgical instrument are for all formsof surgery and by way of example, neurosurgery, cardiac, orthopedic,autolaryngeal, maxilla-facial, obstetric, gynecology, pediatric,plastic, reconstruction and urological.

Embodiments are of the macrosurgical instrument which is an instrumentabout twice the size of a microsurgical instrument and similar inoutward respects. The macrosurgical instrument is used, including, onoperating on the abdominal cavity, bowels/intestine, a hernia and thelike.

Advantages

The previously described versions of the present invention have manyadvantages. The instrument provides the advantages being ergonomical,being all-in-one performing the functions of dilation, irrigation,aspiration and cauterization, eliminating the need for a surgeon-user tofumble around in switching between instruments, reducing timeconsumption and reducing frustration.

The instrument provides the advantages of being sizable as amicroinstrument and having four cooperating functions of dilation,irrigation, aspiration and cauterization. Another advantage is amechanism for controlling irrigation-fluid and aspiration-suction thatoccupies a small and minimized volume such that it is containable in aninstrument for microsurgery. Another advantage is that the instrumenthas an industrial design whose cost to manufacture is low in cost undercurrent market conditions for medical services and therefore theinstrument is economically disposable.

Another advantage is a trigger that is actuated by a user with theuser's third (middle) finger allowing the user to keep the user's firstfinger (thumb) and second (index) finger stationary. Another advantageis that the trigger is positioned below the forceps-like arms forrelatively enhanced ergonomics compared to the state of the art. Anotheradvantage is a trigger/valve that requires relatively reduced force toactuate in the environment of achieving other advantages mentionsherein. Another advantage is a short travel distance for the trigger.

Another advantage is natural and non-awkward finger positioning. Anotheradvantage is a high level of instrument support within the hand. Anotheradvantage is that the instrument is lightweight.

To invent a surgical instrument which provided these advantages posedmany technical problems and engineering challenges for which innovationwas required. One of the problems and engineering challenges was toinnovate a mechanism for controlling irrigation-fluid andaspiration-suction that it occupied a small and minimized volume andcould be contained in an instrument for microsurgery.

Another technical problem and engineering challenge was to innovate amechanism for controlling irrigation-fluid and aspiration-suction thatrequired relatively reduced force to actuate a trigger/valve in theenvironment of achieving the other advantages mentioned herein. Anotherinterrelated technical problem and engineering challenge was to innovatea mechanism for controlling irrigation-fluid and aspiration-suction thatwas lightweight, low in cost and disposable.

A series of interrelated technical problems and engineering challengeswas to innovate a design that maintained or improved the level ofergonomics as compared to the state of the art. There needed to beinnovation that resulted in the following human factors beingacceptable: required force on the trigger, travel distance for thetrigger, finger positioning and supportable within a user's hand.

The above recitation is exemplary and not limiting.

EXAMPLES

The following examples further describe and demonstrate embodimentswithin the scope of the present invention. The examples are given solelyfor the purpose of illustration and are not to be construed aslimitations or restrictions of the present invention, as persons skilledin the art will quickly realize many variations thereof are possiblethat are all within the spirit and scope of the invention.

Example 1

Example 1 is a proof of concept mockup of the instrument according tothe present invention with a single plunger-like trigger. Referring toFIG. 5, this mock up had the principal parts, including, of a righthousing, left cover, trigger, two pinch sliders, a Y-connector, acompression spring, two silicone tubes, a pipette tip and two metaltips.

Example 2

Example 2 is an analysis of operational parameters of the proof ofconcept mockup of Example 1 (that is, a single plunger-like trigger andillustrated in FIG. 5.) The longitudinal travel distance on the triggerwas 0.4 inches. In this mockup, the finger position felt natural and thetravel distance was acceptable. Referring to FIG. 9B, the initialrequired force on the trigger was 28 ounces. As the trigger traveled, apinch slider slides up a recess of a elongated slide surface of thetrigger and concomitantly pinching close a silicone tube. The maximumforce required on the trigger was 46.4 ounces. The required force rampsat a maximum of 42.90 degrees.

Example 3

Example 3 is a proof of concept mockup of an instrument according to thepresent invention with a double plunger-like trigger. Referring to FIG.7, it was constructed using silicone tubing having a 0.125 inch outsidediameter by 0.063 inch inside diameter. The force to pinch close thesilicone tubing with a 0.188 inch rod was 9.0 ounces. The force to pinchclose the silicone tubing with a 0.128 inch rod was 7.5 ounces. Theforce to pinch close the silicone tubing with a 0.093 inch rod was 7.0ounces. The compression at closure was approximately 0.045 inches.

Example 4

Example 4 is another proof of concept mockup of an instrument accordingto the present invention with a double plunger-like trigger. Referringto FIG. 7, it was constructed using silicone tubing having a 0.093 inchoutside diameter by 0.018 inch inside diameter. The force to pinch closethe silicone tubing with a 0.093 inch rod was 6.0 ounces. Thecompression at closure was approximately 0.060 inches.

Example 5

Example 5 is an analysis of force verses travel distance of the proof ofconcept mockups of Examples 3 and 4 with a double plunger-like trigger(see, illustration in FIG. 7.) Referring to FIG. 9A, the required forceramps at a maximum of 22.62 degrees.

Example 6

Example 6 is a proof of concept mockup of an instrument according to thepresent invention with a rocker-like trigger. Referring to FIG. 6, thismock up had the principal parts, including, of right housing, leftcover, trigger and slider. A spring and pinch cylinders are internalwithin the housing.

Example 7

Example 7 is hypothetical example setting out a prospective utilizationof an embodiment of the invention as claimed in claim 12. In a surgicalprocedure, as surgeon (user,) performs dilation. The dilation tips (40)are spread apart in the resting state of the instrument. Thereafter thesurgeon irrigates to clean out debris. The fluid from the irrigationalso serves to open the vessel. Next, the surgeon dissect to clean awaydebris. This dissection is followed by aspiration to suck out fluid andremove debris. Finally, the surgeon performs anastomosis to suture theblood vessel. At times during this procedure, the surgeon performscauterization.

In this hypothetical example it is inferred and induced that theinstrument would fit comfortably in the area of the web of a user's handbetween a thumb and a index finger and the posterior arcuate a curlyqueue tail would fit around the fleshy thenar eminence of the user'spalm underneath the user's thumb. It is further inferred and inducedthat that the instrument is more practical and ergonomically superiorthan prior art devises none of which are believed to have all thefunctions. It is further inferred and induced that the instrumentprovides for better gripping for more effective manipulation and greatercomfort for easier and longer use without fatigue than prior artdevises, none of which are believed to have all the functions.

Although the present invention has been described in considerable detailwith reference to certain preferred versions thereof, other versions arepossible with substituted, varied and/or modified materials and stepsare employed. For example, referring to FIG. 8, the handle portion (60)can have an open area (61). For another example, instead of a disposablethe four function microsurgical instrument, instrument is in a modularconfiguration so that the instrument can be disassembled for easycleaning and reassembled. Preferably, there is one module comprised ofthe forceps-like side arms with a harness or docking apparatus forreception to the central body portion. There are other units containingthe other components of the instrument as previously described. Theseother versions do not depart from the invention. Therefore, the spiritand scope of the appended claims should not be limited to thedescription of the preferred versions contained herein.

1. A surgical instrument possessing the four functions of vesseldilation, irrigation, aspiration and cauterization for use by a usercomprised of: a. a housing comprised of: i. a body portion having alongitudinal axis so as to define forward and posterior directions; ii.a handle portion that depends from the body portion and iii. a butt thatextends from the body portion in the posterior direction; b. a pair ofoppositely opposed forceps-like arms that extend in the forwarddirection from the body portion that are resiliently mounted to the bodyportion and insulative with each forceps-like arm having a distal end;c. A dilation tip at each distal end of each of the forceps-like armthat are electrical conducting and communicable with electrical power;d. a common conduit that extends in the forward direction from the bodyportion for the delivery irrigation-fluid and aspiration-suction inproximity to the dilation tips; and e. a triggered controlledirrigation-fluid and aspiration-suction transmission system partiallydisposed in the housing and comprising: a trigger having a forwardportion and a posterior portion, where said posterior portion has afirst elongated slide surface which has a first recess and a secondelongated slide surface that is substantially parallel to the firstelongated slide surface and which has a second recess where said secondrecess is posterior relative to the first recess and where said triggerdisplaces in the posterior direction; a means for biasing the triggerforward; a first pinch slider having a first pinching back surface andan oppositely opposed first ride surface where the first ride surfacerides on the first elongated slide surface; a second pinch slider havinga second pinch surface and an oppositely opposed second ride surfacewhere the second ride surface rides on the second elongated slidesurface; a first pinching back surface oppositely opposed to the firstpinch surface that is spaced apart a distance from the first pinchsurface such that a tube seated between the first pinch surface and thefirst pinching back surface has a substantially open lumen when thefirst ride surface rides in the first recess and has a pinched closedlumen when the first ride surface rides otherwise on the first elongatedslide surface; a second pinching back surface oppositely opposed to thesecond pinch surface that is spaced apart a distance from the secondpinch surface such that a tube seated between the second pinch surfaceand the second pinching back surface has a substantially open lumen whenthe second ride surface rides in the second recess and has a pinchedclosed lumen when the second ride surface rides otherwise on the secondelongated slide surface and a tube seated between the first pinchsurface and the first pinching back surface and a tube seated betweenthe second pinch surface and the second pinching back surface that areconnectable to a common conduit and sources for vacuum and fluid,whereby with about one half displacement of the trigger the lumen of thefirst tube is open with the lumen of the second tube pinched and with anabout full displacement of the trigger the lumen of the second tube isopen with the lumen of the first tube pinched.
 2. The surgicalinstrument of claim 1 where the instrument is sized for being amicrosurgical instrument.
 3. The surgical instrument of claim 1 wherethe instrument is sized for being a macrosurgical instrument.
 4. Thesurgical instrument of claim 1 where the handle portion has a posteriorarcuate.
 5. The surgical instrument of claim 1 where the forceps-likearms have at least one gripping pad.
 6. The surgical instrument of claim1 where the dilation tips are in communication with an electrical powersource and a foot pedal switch for actuation.
 7. The surgical instrumentof claim 1 where the triggered controlled irrigation-fluid andaspiration-suction transmission system has a trigger button means thatextends forward from the handle.
 8. The surgical instrument of claim 1where the triggered controlled irrigation-fluid and aspiration-suctiontransmission system: a. has a trigger button means that is aplunger-like trigger that extends forward from the handle and thatdisplaces longitudinally; and b. is configured so that about a half alongitudinal displacement of the trigger actuates irrigation or suctionand an about full longitudinal displacement of the trigger actuates theother.
 9. The surgical instrument of claim 1 where: a. the handleportion has a posterior arcuate; b. the forceps-like arms have at leastone gripping pad for receiving a user's thumb or first finger; c. thedilation tips are in communication with an electrical power source and afoot pedal switch for actuation and d. the triggered controlledirrigation-fluid and aspiration-suction transmission system: i. has atrigger button means that is a plunger-like trigger that extends forwardfrom the handle and that displaces longitudinally; and ii. is configuredso that about a half a longitudinal displacement of the trigger actuatesirrigation or suction and an about full longitudinal displacement of thetrigger actuates the other.
 10. A surgical instrument possessing thefour functions of vessel dilation, irrigation, aspiration andcauterization for use by a user comprised of: a. a housing comprised of:i. a body portion having a longitudinal axis so as to define forward andposterior directions, a pair of oppositely opposed lateral sides, frontside and an upper side; ii. a handle portion that depends from the bodyportion approximately perpendicular to the longitudinal axis of the bodyportion so as to define a lower direction having oppositely opposedlateral sides, a forward side, a lower side and a posterior side thathas an arcuate shape so as to form a saddle which sits in the firstpalmar web space of the user's hand resting against the thenar eminenceof the user's hand where the handle portion has a width that is suitablefor grasping between the thenar eminence and a curled middle finger thatrests on the finger contact surface of a single button plunger-liketrigger button and iii. a butt portion that extends in the posteriordirection from the body portion about along the longitudinal axis of thebody portion with an upper side, oppositely opposed lateral sides,posterior side and a lower side that is restable on at least a portionof the first dorsal web space of a user's hand; b. a pair of oppositelyopposed forceps-like arms that extend in the forward direction from thebody portion about along the longitudinal axis of the body portion thatare resiliently mounted to the body portion and insulative with eachforceps-like arm having a distal end; c. A dilation tip at each distalend of each of the forceps-like arm that is electrically conducting andin communication with an electrical power source and an actuation meansfor electrical power; d. a common conduit that extends in the forwarddirection from the body portion between the pair of oppositely opposedforceps-like arms about along the longitudinal axis of the body and hasan end in proximity to the dilation tips; e. a triggered controlledirrigation-fluid and aspiration-suction transmission system partiallydisposed in the housing and comprising: a trigger having a forwardportion and a posterior portion, where said posterior portion has afirst elongated slide surface which has a first recess and a secondelongated slide surface that is substantially parallel to the firstelongated slide surface and which has a second recess where said secondrecess is posterior relative to the first recess and where said triggerdisplaces in the posterior direction; a means for biasing the triggerforward; a first pinch slider having a first pinching back surface andan oppositely opposed first ride surface where the first ride surfacerides on the first elongated slide surface; a second pinch slider havinga second pinch surface and an oppositely opposed second ride surfacewhere the second ride surface rides on the second elongated slidesurface; a first pinching back surface oppositely opposed to the firstpinch surface that is spaced apart a distance from the first pinchsurface such that a tube seated between the first pinch surface and thefirst pinching back surface has a substantially open lumen when thefirst ride surface rides in the first recess and has a pinched closedlumen when the first ride surface rides otherwise on the first elongatedslide surface; a second pinching back surface oppositely opposed to thesecond pinch surface that is spaced apart a distance from the secondpinch surface such that a tube seated between the second pinch surfaceand the second pinching back surface has a substantially open lumen whenthe second ride surface rides in the second recess and has a pinchedclosed lumen when the second ride surface rides otherwise on the secondelongated slide surface; and a tube seated between the first pinchsurface and the first pinching back surface and a tube seated betweenthe second pinch surface and the second pinching back surface that areconnectable to a common conduit and sources for vacuum and fluid,whereby with about one half displacement of the trigger the lumen of thefirst tube is open with the lumen of the second tube pinched and with anabout full displacement of the trigger the lumen of the second tube isopen with the lumen of the first tube pinched.
 11. The surgicalinstrument of claim 10 where the instrument is sized for being amicrosurgical instrument.
 12. The surgical instrument of claim 10 wherethe instrument is sized for being a macrosurgical instrument.
 13. Thesurgical instrument of claim 10 where the forceps-like arms have atleast one gripping pad for receiving a user's thumb or first finger. 14.The surgical instrument of claim 10 where the actuation means forelectrical power is a foot pedal switch.
 15. The surgical instrument ofclaim 10 where: a. the forceps-like arms have at least one gripping padfor receiving a user's thumb or first finger; and b. the actuation meansfor electrical power is a foot pedal switch.
 16. A triggered controlledirrigation-fluid and aspiration-suction transmission system for asurgical instrument comprised of: a. a trigger having a forward portionand a posterior portion, where said posterior portion has a firstelongated slide surface which has a first recess and a second elongatedslide surface that is substantially parallel to the first elongatedslide surface and which has a second recess where said second recess isposterior relative to the first recess and where said trigger displacesin the posterior direction; b. a means for biasing the trigger forward;c. a first pinch slider having a first pinching back surface and anoppositely opposed first ride surface where the first ride surface rideson the first elongated slide surface; d. a second pinch slider having asecond pinch surface and an oppositely opposed second ride surface wherethe second ride surface rides on the second elongated slide surface; e.a first pinching back surface oppositely opposed to the first pinchsurface that is spaced apart a distance from the first pinch surfacesuch that a tube seated between the first pinch surface and the firstpinching back surface has a substantially open lumen when the first ridesurface rides in the first recess and has a pinched closed lumen whenthe first ride surface rides otherwise on the first elongated slidesurface; f. a second pinching back surface oppositely opposed to thesecond pinch surface that is spaced apart a distance from the secondpinch surface such that a tube seated between the second pinch surfaceand the second pinching back surface has a substantially open lumen whenthe second ride surface rides in the second recess and has a pinchedclosed lumen when the second ride surface rides otherwise on the secondelongated slide surface; and g. a tube seated between the first pinchsurface and the first pinching back surface and a tube seated betweenthe second pinch surface and the second pinching back surface that areconnectable to a common conduit and sources for vacuum and fluid,whereby with about one half displacement of the trigger the lumen of thefirst tube is open with the lumen of the second tube pinched and with anabout full displacement of the trigger the lumen of the second tube isopen with the lumen of the first tube pinched.
 17. The triggered controlsystem for irrigation-fluid and aspiration-suction of claim 16 where themeans for biasing the trigger forward is a compression spring spanningdistally from the trigger to a contact point on the housing.